24 April 1971 S.A. MEDICAL JOURNAL 473 Bislol'Y 01 Medicine THE SWEATING SICKNESS IN ENGLAND* ARCHIBALD W. SLOAN, Professor of Physiology, University of Cape Town SUMMARY blood with a most ardent heat ... so that, of all of them An acute infect;ous fever, called the sweating sickness, that sickened, there was not one among a hundred that broke out in England in five major epidemics in the years escaped." 1485, 1508, 1517, 1528 and 1551. Only one epidemic, thal HoIinshed, who closely follows Hall's description of the of 1528, spread also on the continent of Europe. The outbreak, states that the epidemic began on about 21 disease I-vas characterized by headache, pain in the chest, September and lasted until the end of October," but Webb and profuse sweating, and frequently proved fatal within maintains that it reached Oxford at the end of August, 24 hours. it can be distinguished from plague, malaria, and killing many students and causing many others to flee, and typhus, all of which were prevalent in the 161h century, reached London only a few days later: and was probably not influenza but anoTher virus infection It is widely assumed that the disease was brought into which has not reappeared in England since 1551. the country by the mercenary troops which the Earl of Richmond (later Henry VII) brought with him from France One of the unsolved mysteries of medical history is the to the battle of Bosworth Field (22 August 1485), but nature of the sweating sickness, an acute and often fatal there is no account of any such epidemic at the time on illness, which swept across England in five great epidemics the continent of Europe. There is no doubt however that III the 15th and 16th centuries. It was also referred to as the sweating sickness broke out in London within 3 weeks 'the sweat' or 'the English sweat'. With one major and one of the entry of the Earl of Richmond's army into the minor exception the epidemics were limited to England city. The processions and pageants organized to welcome and Wales but the mortality in affected areas was almost the new monarch were interrupted by the epidemic, which as high as in the worst outbreaks of plague. killed the Lord Mayor, his successor, and six aldermen within a week.' But it ceased as suddenly as it began The Epidem;c of 1485 and, on 30 October, Henry was crowned 'with a mag­ The best-known description of the first epidemic of nificence which had probably never at this time been sweating sickness, in 1485, is by John Caius, who was born equalled at the coronation of any English monarch'." 25 years after the event but was an eye-witness of the Polydore Vergil, court historian to Henry VII, described last epidemic in 1551: the sudden onset and unprecedented severity of the epi­ 'In the year of our Lord God, 1485, shortly after the demic and also the main clinical features and the recom­ 7th day of August, at which time King Henry VII arrived mended treatment: at Milford in Wales out of France, and in the first year of 'A sudden deadly sweating attacked the body and, at the his reign, there chanced a disease among the people, lasting same time, head and stomach were in pain from the the rest of that month and all September which, for its violence of the fever. When seized by the disease some sudden sharpness and unwonted cruelty, surpassed the were unable to bear the heat and (if in bed) removed the pestilence. For this commonly gives 3 or 4, often 5, some­ bedclothes or (if clothed) undressed themselves; others times 9, sometimes 11, and sometimes 14 days respite to slaked their thirst with cold drinks, yet others endured whom it vexes. But that (the sweat) immediately killed the heat and the stench (for the perspiration stank some in opening their windows, some in pla~ling with foully) and, by adding more bedclothes, provoked more children in their street doors, some in one hour, many sweating. But all alike died, either as soon as the fever in two it destroyed and, at the longest, to them that began or not long after so that, of all of the persons merrily dined it gave a sorrowful supper. As it found them infected, scarcely one in a hundred escaped death.''' so it took them, some asleep some awake, some in mirth, 'Anyone who is attacked by the sweating by day should some in care, some fasting and some full, some busy and retire to bed, dressed just as he is; if the perspiration begins some idle, and in one house sometimes three sometimes at night, while he lies in bed, he should lie quietly and not five, sometimes seven sometimes eight, sometimes more move from it for exactly twenty-four hours. Meanwhile he sometimes all, of which, if the half in every town escaped, should add more bedclothes, not thereby to provoke the it was thought great favour." t fever, but so that he should perspire gently and naturally. An earlier report is found in Hall's chronicle: He should take nothing to eat if he can suffer hunger for so long, but may drink enough of his usual drink, warmed, 'In this same year a new kind of sickness came suddenly to quench his thirst. In this treatment care should chiefly through the whole region even after the first entering of be taken not to allow even an arm to be exposed for the king into this isle, which was so sore, so painful and coolness outside the bedclothes, for this is fatal." sharp that the like was never heard of to any man's Thomas Forrestier, a French physician who was resi­ remembrance before that time. For suddenly a deadly dent in London at the time, gives a similar description of and burning sweat invaded their bodies and vexed their an attack of the sweating sickness and speculates on its origin. The far causes of the disease, he concludes, are *Date received: 7 January 1971. astrological. tThis and other early reports of the sweating sickness are here rendered in modem English spelling and punctuation. 'The nigh causes be the stinking of the earth as it is in -,~--------------------~~-- 474 S.-A. MEDIESE TYDSKRIF 24 April 1971 many places, as in deep caves and stinking nigh to silver The Epidemic of 1528 mines, and venoms, or nigh to dead beasts, or nigh to A succinct description of the sweating sickness, as it was. dragons or serpents, or nigh to stinking waters, for these manifested in the fourth epidemic, is found in a letter be great causes of putrefaction, and these corrupt the air written from London by the French ambassador, Du and so our bodies are infected by that corrupt air.'s Bellay, who himself survived an attack of the disease: Forrestier prescribed a simple diet, purgation, blood­ 'This disease, which broke out here four days ago, is. letting, pills, syrups, and an electuary with 46 ingredients. the easiest in the world to die of. You have a slight pain He ascribed much of the mortality to unskilled leeches in the head and at the heart; all at once you begin to who 'do not know the causes, complexions, ages, regions, sweat. There is no need for a physician; for if you uncover times of the year, climate, natures, or how much of the yourself the least in the world, or cover yourself a little medicine to prescribe'. too much, you are then taken off without languishing, as. The sweating sickness was no respecter of rank. Unlike those dreadful fevers make you do.'" the plague, which was typically a disease of the poor, it There were about 40000 cases of the disease in London affected the highest classes of society and appeared to in five weeks, with about 2000 deatbs. The epidemic single out young, previously healthy men. From London coincided with Henry VIII's whirlwind courtship of Anne the epidemic spread to other towns in England but not to Boleyn. 'As soon as he heard of her infection, Henry cast Scotland, Ireland, or the continent of Europe. gallantry to the winds and fled from her side, keeping on the move for several weeks, dosing himself with numerous: The Epidemic of 1508 medicaments, hearing three Masses and confessing daily, The date of the second epidemic of sweating sickness it was said, and communicating frequently. True he wrote has been disputed, but the balance of evidence favours lovingly to Anne lamenting his separation from her and 1508." Many members of the royal household were comforting her with the information that the sweat seemed affected; the Lord Treasurer died and the Lord Privy Seal to spare women; but the effect was spoiled by a two-edged and the Lord Chamberlain contracted the disease but envoi which begged her not to come back too soon.,18 recovered. The court moved from London and a strict edict Anne recovered from her attack and Henry, temporarily was issued that nobody from London was to come near reunited with his queen, escaped infection. 'The king, for a the court and that nobody from the court was to visit the city.'· space, removed almost every day till at the last he came to This epidemic was confined to England and had a much Tytynhangar, a place of the abbot of St Albans, and there lower mortality than its predecessor.ll According to some he with a few determined to bide the chance that God this was due to the efficacy of the treatment (complete rest would send him, which place was so purged daily with and moderate warmth), which had been developed during fires and other preservatives that neither he nor his queen the first epidemic.